Provider Demographics
NPI:1609947332
Name:PENEMARIE K MURPHY, INC
Entity Type:Organization
Organization Name:PENEMARIE K MURPHY, INC
Other - Org Name:PHYSICAL THERAPY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:PENEMARIE
Authorized Official - Middle Name:KALLAS
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:904-645-7400
Mailing Address - Street 1:PO BOX 11677
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32239-1677
Mailing Address - Country:US
Mailing Address - Phone:904-745-0302
Mailing Address - Fax:904-745-0750
Practice Address - Street 1:425 N LEE ST
Practice Address - Street 2:SUITE 102
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-1127
Practice Address - Country:US
Practice Address - Phone:904-353-9008
Practice Address - Fax:904-353-3215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2009-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY908YOtherBCBS FL
FL5490100OtherAETNA
FL102330OtherAVMED
FL880295500Medicaid
FLK0803Medicare ID - Type UnspecifiedGROUP
FLY2843DMedicare ID - Type UnspecifiedINDIVIDUAL